title: Dispensing patterns and pregnancy outcomes for women dispensed selective serotonin reuptake inhibitors in pregnancy.
abstract: BACKGROUND
  The safety of selective serotonin reuptake inhibitors (SSRIs) during pregnancy remains uncertain. The purpose of this study was to investigate dispensing patterns and pregnancy outcomes for women dispensed an SSRI in pregnancy.
  
  
  METHODS
  Using data linkage of population-based health datasets from Western Australia and a national pharmaceutical claims dataset, our study included 123,405 pregnancies from 2002 to 2005. There were 3764 children born to 3703 women who were dispensed an SSRI during their pregnancy.
  
  
  RESULTS
  A total of 42.3% of the women were dispensed an SSRI in each trimester, and 97.6% of the women used the same SSRI throughout the first trimester without switching. The women who were dispensed an SSRI were more likely to give birth prematurely (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.2-1.7), to have smoked during the pregnancy (OR, 1.9; 95% CI, 1.8-2.1), and parity>1 (OR, 1.7; 95% CI, 1.5-1.8). The singletons were found to have a lower birth weight than expected when other factors were taken into account (OR, 1.2; 95% CI, 1.1-1.3). There was an increased risk of major cardiovascular defects (OR, 1.6; 95% CI, 1.1-2.3). The children of women dispensed citalopram during the first trimester had an increased risk of vesicoureteric reflux (OR, 3.1; 95% CI, 1.3-7.6). Children born to women dispensed sertraline had a higher mean birth weight than those born to women dispensed citalopram, paroxetine, or fluoxetine. This pattern was also seen in birth length.
  
  
  CONCLUSIONS
  Most women were dispensed the same SSRI throughout their pregnancy. We have confirmed previous findings with an increased risk of cardiovascular defects and preterm birth. New findings requiring confirmation include an increased risk of vesicoureteric reflux with the use of citalopram.
authors.affiliation: Telethon Institute for Child Health Research, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia. lync@ichr.uwa.edu.au
authors.forename: Lyn
authors.initials: L
authors.lastname: Colvin
authors.forename: Linda
authors.initials: L
authors.lastname: Slack-Smith
authors.forename: Fiona J
authors.initials: FJ
authors.lastname: Stanley
authors.forename: Carol
authors.initials: C
authors.lastname: Bower
mesh_terms: D000025:Abortion, Eugenic / Q000706:statistics & numerical data; D016907:Adverse Drug Reaction Reporting Systems / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D019964:Mood Disorders / Q000188:drug therapy* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000453:epidemiology; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011261:Pregnancy Trimester, First / Q000187:drug effects / Q000502:physiology; D011271:Pregnancy, Ectopic / Q000139:chemically induced / Q000453:epidemiology; D012042:Registries; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors